NU471 Week 5 EAQ #4 Evolve Elsevier: Disaster Planning - Mastery Level Target: Level 3

When writing a disaster plan for implementation during a mass casualty incident (MCI), which percentage of victims often require admission to the hospital for further treatment? o 25% o 30% o 35% o 40%

o 30% · The disaster plan should include provisions for approximately 30% of the victims of an MCI requiring hospital admission. The other percentages, 25, 35, and 40 are not accurate numbers to include in the disaster plan.

Which would the nurse describe as an example of an internal disaster? o Tornado o Hurricanes o Fire or explosion o Terrorism attacks

o Fire or explosion · An internal disaster refers to an event that impairs the hospital's normal functioning and disrupts normal client care activities. Examples include a fire or explosion and the loss of critical utilities. Tornado, hurricanes, and terrorist attacks are external disasters that result in the loss of lives and property.

Which training will help nurses identify signs of biological terrorism? o Mass casualty incident (MCI) o Hazardous materials (HAZMAT) o Federal Emergency Management (FEMA) o Community Emergency Response Team (CERT)

o Hazardous materials (HAZMAT) · Staff in the emergency department will be trained for HAZMAT, which they will use to manage the handling and identification of hazardous materials. An MCI is the actual disaster where there are many casualties. FEMA is a federal agency that oversees emergency responses across the country. The CERT responds to disasters for search and rescue, but not managing hazardous materials.

Which statement made by the nursing student indicates effective learning about the pathophysiology of submersion injury in victims of freshwater drowning and victims of saltwater drowning? o "Fresh water is hypertonic whereas salt water is hypotonic." o "Both types of water are drawn from the vascular space into the alveoli." o "Destruction of surfactant and alveolar-capillary membrane occurs only in case of saltwater aspiration." o "The osmotic gradient caused by the aspirated fluid causes fluid imbalances in case of submersion in both types of water."

o "The osmotic gradient caused by the aspirated fluid causes fluid imbalances in case of submersion in both types of water." · There is a difference in tonicity of both salt water and fresh water with that of normal body fluids. When either saltwater or freshwater is aspirated by the submerged victim, the osmotic gradient caused by the aspirated fluid causes fluid imbalances in the body. Freshwater is hypotonic and saltwater is hypertonic. Only hypertonic saltwater draws fluid from the vascular space into the alveoli. Destruction of surfactant and alveolar-capillary membrane occurs in cases of both saltwater and freshwater aspiration.

Which type of health care does a person who is "worried well" require? Select all that apply. o Evaluation o Reassurance o Hospitalization o Diagnostic tests o Preventive treatment

o Evaluation o Reassurance o Preventive treatment · A person who is "worried well" wants evaluation, reassurance, and preventive treatment. This person does not ask for hospitalization or diagnostic tests.

Which action would the nurse identify as a potential contributor to staff post-traumatic stress disorder (PTSD) during a mass casualty assessment? o Working less than 12 hours o Encouraging and motivating team members o Working continuously without any breaks o Discussing feelings with the team members

o Working continuously without any breaks · Working continuously without any breaks will result in increased stress. Working less than 12 hours may reduce stress. By motivating team members, PTSD can be prevented. By discussing feelings with team members or nurse managers, stress can be reduced.

Which treatment for anthrax would be included in the biological agent portion of a disaster plan for terrorist attacks? o Antivirals o Antitoxins o Antibiotics o Vaccinations

o Antibiotics · Anthrax is treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant. Antivirals would not be effective against anthrax, and there is no established treatment for most viruses that cause hemorrhagic fever. Botulism is treated with antitoxin, though several vaccines are being studied. Smallpox can be prevented or the incidence reduced by vaccination, even when first given after exposure.

Which new triage level would the emergency department (ED) nurse training to be a member of a direct response team to respond to community emergencies be required to learn? o Urgent o Emergent o Expectant o Nonurgent

o Expectant · The expectant classification is not a classification level in ED triage. The levels urgent, emergent, and nonurgent are all classification levels within an ED triage system.

Who would the nurse contact to receive training as a Community Emergency Response Team (CERT) member? o National Disaster Life Support Foundation o Federal Emergency Management Agency (FEMA) o Centers for Disease Control and Prevention (CDC) o Centers for Medicare and Medicaid Services (CMS)

o Federal Emergency Management Agency (FEMA) · FEMA provides CERT training. The National Disaster Life Support Foundation offers core, basic, and advanced disaster life support training courses. The CDC and CMS do not provide disaster preparedness training.

Which method of delivering client care works well in disaster situations? o Team nursing o Primary nursing o Functional nursing o Total client care nursing

o Functional nursing · The functional method of delivering care works well in emergency and disaster situations. Each care provider knows the expectations of the assigned role and completes the tasks quickly and efficiently. Team nursing, primary nursing, and total client care nursing are not the ideal models for delivering client care during disaster situations.

Which team member acts as a liaison between the health care facility and the media? o Triage officer o Public information officer o Medical command physician o Hospital incident commander

o Public information officer · The public information officer acts as a liaison between the health care facility and the media. The triage officer applies disaster triage tags after evaluating the client's condition. The medical command physician decides the number, acuity, and resource needs of clients. The hospital incident commander assumes overall leadership for implementing the emergency plan.

Which agent of terrorism can cause death within a few minutes? o Sarin gas o Uranium o Iodine-131 o Mustard gas

o Sarin gas · Sarin gas is an agent for bioterrorism that can cause death within minutes of exposure by paralyzing respiratory muscles. Uranium and iodine-131 can be dangerous in close proximities but are not as harmful as sarin gas. Mustard gas causes blisters on the skin but does not cause death within a few minutes.

Which statement made by the student nurse indicates effective knowledge regarding mass casualty incidents (MCIs)? o "Two-thirds of victims are generally tagged red or black." o "The triage of victims of an MCI must be conducted in 1 minute." o "Victims who arrive at the hospital on their own are not considered during triage." o "The total number of victims can be estimated by doubling the number of victims who arrive in the first hour."

o "The total number of victims can be estimated by doubling the number of victims who arrive in the first hour." · The total number of victims a hospital can expect is estimated by doubling the number of victims who arrive in the first hour. In general, two-thirds of victims are tagged green or yellow, and the rest of them are tagged red or black. Triage of victims of an MCI must be conducted in less than 15 seconds. Victims who arrive at the hospital on their own are known as "walking wounded" and are considered during triage.

In which situation would activation of the emergency preparedness plan be necessary? Select all that apply. o 19 victims of a collapsed pleasure boat brought to a community hospital at 1 AM Saturday o 5 victims of suspected food poisoning are brought to an urban hospital at 2 PM on Tuesday o 75 victims of a manufacturing plant explosion are brought to an urban hospital at 3 AM on Friday o 25 victims of a bus accident are brought to a community hospital for treatment on Christmas morning o 30 victims of a fire in a senior citizen's housing facility brought to a community hospital at 5 PM Monday

o 19 victims of a collapsed pleasure boat brought to a community hospital at 1 AM Saturday o 75 victims of a manufacturing plant explosion are brought to an urban hospital at 3 AM on Friday o 25 victims of a bus accident are brought to a community hospital for treatment on Christmas morning o 30 victims of a fire in a senior citizen's housing facility brought to a community hospital at 5 PM Monday · When the number of casualties exceeds the usual resource capabilities, a disaster situation exists. The pleasure boat victims are being taken to a community hospital on a Saturday night when staffing is typically lower. Likewise, the victims of a manufacturing plant explosion are being taken to an urban hospital during the time of lower staffing. The victims of a bus accident are being taken to a community hospital on a holiday, during which staffing is generally lower. The number of victims from a senior citizen's housing facility fire is large and could overwhelm available resources at the community hospital. The victims of food poisoning can easily be taken care of by existing staff and resources at an urban hospital on a weekday afternoon.

Which nursing action is correct when the state department of health recommends administering tetanus vaccine to pregnant women who have not received it previously? o Avoiding giving the vaccine to pregnant women who are in their first trimester o Administering the vaccine to pregnant women at any gestational age o Revaccinating pregnant women who received tetanus vaccine last year o Avoiding vaccinating pregnant women who are at high risk for preterm labor

o Administering the vaccine to pregnant women at any gestational age · A tetanus toxoid containing vaccine might be recommended for wound management in pregnant women. This vaccine can be given at any gestational age for women who have not received it previously. The tetanus toxoid containing vaccine can be given to pregnant women at any gestational age and does not need to be avoided during the first trimester. Revaccinating can be done if a period of 5 years or more has elapsed since the last vaccination. There is no need to avoid vaccinating pregnant women who are at risk for preterm labor.

Which functions would the medical command physician perform with respect to the emergency preparedness and response plan for clients after a natural disaster? Select all that apply. o Anticipates the number of clients o Checks the resource needs for clients o Monitors and implements the emergency response plan o Evaluates each client to determine priorities for treatment o Serves as a liaison between the health care facility and the media

o Anticipates the number of clients o Checks the resource needs for clients · A medical command physician anticipates the number of clients and assesses client needs as part of emergency preparedness and response plan. The hospital incident commander monitors and implements the emergency response plan. A triage officer evaluates each client to determine priorities for treatment. A community relations or public information officer serves as a liaison between the health care facility and the media.

Which is the most appropriate nursing intervention to prevent further injury in the client who was injured in a tornado and is disoriented? o Keeping rails up on the stretcher o Keeping the stretcher in lowest position o Maintaining adequate lighting in the room o Asking a family member to remain with the client

o Asking a family member to remain with the client · Asking a family member or significant person who cares for the client to remain with the client will help reduce confusion in the client. It is the most important intervention to prevent injury in the client. Keeping rails up on the stretcher will help prevent injury in the client, but it is not the most appropriate intervention. Keeping the stretcher in the lowest position will prevent injury, but it is not the most appropriate intervention in clients. Maintaining adequate lighting in the room will help prevent injury from a fall, but it is not the most appropriate intervention in case of disoriented or confused clients.

According to the disaster triage tag system, which color tag would the nurse feel is most suitable for a client who died in an earthquake? o Red o Black o Green o Yellow

o Black · Clients who are dead or are expected to die are issued a black tag according to the disaster triage tag system. A red tag is issued to the clients who have an immediate threat to life. A green tag is issued to the nonurgent or "walking wounded" clients. A yellow tag is issued to clients who can wait a short time to receive care.

After an earthquake that has caused mass casualties, which color tag would be given to the client with a massive head injury who does not respond to stimulation and cannot breathe independently? o Red tag o Black tag o Green tag o Yellow tag

o Black tag · In an incident that has caused mass casualties, a military form of triage is performed to provide the best care for the most people. In such instances, clients who may otherwise have been resuscitated are often classified as expectant. A client with a massive head injury who is unable to respond to any kind of stimulus and is unable to breathe independently would be classified with a black tag. Clients needing emergency medical care are identified with red tags. Green tags are given to the clients who sustained minimal injuries in the disaster. Yellow tags are given to clients whose treatment can be delayed for a short time.

Which disasters would the nurse categorize as natural events? Select all that apply. o Blizzard o Droughts o Wildfires o Nuclear explosion o Industrial accidents

o Blizzard o Droughts o Wildfires · Natural disasters include weather-related events that inflict significant damage to life and property, exceeding the resource capabilities of local communities. Blizzards, droughts, and wildfires are a few examples of natural disasters. Man-made occurrences are related to identifiable human actions and also include technological events such as nuclear explosions and major industrial accidents.

Based on the data in the table, which client who arrived at the hospital after a large-scale disaster is appropriately tagged according to the disaster triage tag system? Client A: Massive head injury - Red tag issued Client B: Compound fracture - Green tag issued Client C: 90% of body with full thickness burns - Black tag issued Client D: Skin lacerations - Yellow tag issued o Client A o Client B o Client C o Client D

o Client C · Clients who are expected to die are issued black tags. Client C with full-thickness burns is triaged into the expectant category and would be given a black tag. Clients who require immediate treatment are issued red tags. Client A with a massive head injury would likely be triaged into the expectant category and would be given a black tag, not a red tag. A yellow tag is issued to clients with major injuries such as compound fractures. So, client B with a compound fracture should be given a yellow tag. Green tags are issued to clients with minor injuries. So, client D with skin lacerations should be issued a green tag.

Which client being triaged during a disaster would the nurse classify as emergency severity level 2 (ESI-2) using the Emergency Severity Index? Select all that apply. o Client experiencing cardiac arrest o Client in severe respiratory distress o Client with chest pain from ischemia o Client experiencing bradypnea postoverdose o Client with multiple trauma who is responsive

o Client with chest pain from ischemia · A client experiencing chest pain with ischemia would be classified as ESI-2. Clients experiencing cardiac arrest, severe respiratory distress, and bradypnea postoverdose would be classified as ESI-1. A client with multiple trauma who is unresponsive would be classified as ESI-2.

Which is the critical factor among health care professionals, state agencies, and federal agencies to determine when and how to evacuate safely during a natural disaster? o Cooperation o Classification o Collaboration o Communication

o Communication · Communication is the critical factor among health care professionals, state agencies, and federal agencies to determine when and how to evacuate safely during a natural disaster. Cooperation, classification, and collaboration, although important, are not the critical factors to determine when and how to safely evacuate during a natural disaster.

Which is the function of the medical command physician according to the Emergency Preparedness and Response Plan? o Deciding the number, acuity, and resource needs of clients o Serving as a liaison between the health care facility and the media o Assuming overall leadership for implementing the emergency plan o Evaluating each client rapidly to determine priorities for treatment

o Deciding the number, acuity, and resource needs of clients · The function of the medical command physician, according to the Emergency Preparedness and Preparedness Plan, is deciding the number, acuity, and resource needs of clients. The function of the community relations or public information officer is serving as a liaison between the health care facility and the media. The function of the hospital incident commander is assuming overall leadership for implementing the emergency plan. The function of the triage officer is evaluating each client rapidly to determine priorities for treatment.

Which emergency medical service agency offers service for a group of clients admitted to the emergency unit with mass fatalities? o Medical Reserve Corps (MRC) o Hospital Incident Command System (HICS) o International Medical-Surgical Response Teams (IMSRT) o Disaster Mortuary Operational Response Teams (DMORT)

o Disaster Mortuary Operational Response Teams (DMORT) · The National Disaster Medical System (NDMS) is responsible for managing the Federal Government's medical response to medical emergencies and disasters. One of their additional services is the DMORT. DMORTs manage mass fatalities. The MRC offers its services to health care facilities or the community in a supportive to supplemental capacity during times of need, such as a disaster or pandemic disease outbreak. HICS is a part of National Incident Management System (NIMS) that standardizes disaster operations. IMSRT establishes fully functional field surgical facilities.

Which training measure is most effective to adequately familiarize health care providers with emergency response procedures? o Drills o Tabletop exercises o Access to the policy o Computer simulations

o Drills · Hospital disaster drills are priority training measures to familiarize health care providers with emergency response procedure. Other methods that can also be used include tabletop exercises and computer simulations; however, these methods will not provide immersive practice comparable to well-planned drills. Access to the policy is important but will not provide real world experience for emergency response procedures.

Which steps would the nurse explain are to be followed for preventing post-traumatic stress disorder (PTSD) in hospital staff during a mass casualty event? Select all that apply. o Drinking plenty of water o Encouraging coworkers o Monitoring each other's stress levels o Being quiet and isolated from others o Working for more than 12 hours each day

o Drinking plenty of water o Encouraging coworkers o Monitoring each other's stress levels · It is recommended to drink plenty of water and eat healthy snacks for energy to overcome PTSD. It is essential to encourage and support coworkers who are suffering from PTSD. It is suggested that coworkers monitor each other's stress levels and performance during PTSD. It is advised to talk about feelings with staff and managers and be in touch with family, friends, and significant others, rather than isolating oneself. It is important not to work for more than 12 hours each day because it will increase stress and lead to PTSD.

In which order would the nurse perform initial assessments to manage immediate threats in the client who was admitted to an emergency unit with a critical injury from a bomb blast? o Assessing breathing sounds and respiratory effort o Monitoring vital signs o Removing all clothing for a complete physical assessment o Establishing a patent airway by positioning, suctioning, and oxygen as needed o Evaluating the client's level of consciousness using the Glasgow Coma Scale (GCS)

o Establishing a patent airway by positioning, suctioning, and oxygen as needed o Assessing breathing sounds and respiratory effort o Monitoring vital signs o Evaluating the client's level of consciousness using the Glasgow Coma Scale (GCS) o Removing all clothing for a complete physical assessment · The priority intervention in any injured client who survived bomb blast is to establish a patent airway. Establishing a patent airway is done by positioning, suctioning, and administering oxygen as needed. After the patent airway is established, assessing breathing sounds and respiratory effort to determine ventilation is the next priority. When effective ventilation is ensured, the priority shifts to circulation. Circulation is assessed by monitoring vital signs such as blood pressure and heart rate. After assessing circulation, evaluating the client's level of consciousness using the GCS is the next priority. The final component of assessment is removing all clothing for a complete physical assessment.

Which disaster can be categorized as an internal disaster? o Hurricane in a state o Explosion in a hospital o Earthquake in a country o Flooding in a town

o Explosion in a hospital · An internal disaster is any event inside a health care facility or campus that could endanger the safety of clients or staff. An explosion inside a hospital is an example of internal disaster. A hurricane, earthquake, or flooding in a town, all occurring out of the hospital setting but requiring an emergency management plan from the hospital, can be categorized as external disasters.

Which disaster management team member most likely engages to manage the aftermath of an accidental explosion in a fertilizer plant and evacuate the injured and uninjured victims from danger as first line of action? o Nurse o Paramedic o Volunteers o Firefighter

o Firefighter · During a disaster, firefighters and other first responders such as police officers are most likely to be involved in removing the injured and uninjured victims from danger. Nurses are typically not involved in this process, because they require special rescue training. Paramedics are responsible for providing initial care to the victims. Volunteers are supervised by nurses to provide care for the victims injured in disaster.

Which type of emergency assessment is being performed when the nurse is inserting a gastric tube and arranging for diagnostic studies for a client who sustained injuries after a bus accident? o Disability o Breathing o Focused adjuncts o Giving comfort measures

o Focused adjuncts · Emergency assessment of focused adjuncts is performed in a secondary survey. Inserting a gastric tube and arranging for diagnostic studies are included in this type of assessment. Emergency assessment of disability is performed in a primary survey to identify a client's level of consciousness. Emergency assessment of breathing is performed in a primary survey to identify respiratory distress or any need for mechanical ventilation. Giving comfort measures is performed during the secondary survey to provide emotional support to the client and caregiver.

Which medications are used to treat cerebral edema or decrease free water in clients with submersion injuries in the emergency department? Select all that apply. o Atropine o Furosemide o Phencyclidine o Mannitol o Chlorpromazine

o Furosemide o Mannitol · Furosemide or Mannitol is used to treat cerebral edema or decrease free water in clients with submersion injuries. Atropine is used as an antidote for nerve agent poisoning. Phencyclidine is a street drug that is considered to be a risk factor for heat-related emergencies. Intravenous chlorpromazine is the medication of choice to control shivering in victims of heatstroke.

Which color-tagged clients usually make up the greatest number in most large-scale multi-casualty situations, based on the disaster triage tag system? o Red o Black o Green o Yellow

o Green · Green-tags clients usually make up the greatest number in most large-scale multicasualty situations. These clients have minor injuries and they may actually evacuate themselves from the mass casualty scene and go to the hospital in a private vehicle. Red-tagged clients have major injuries, black-tagged clients are expected and allowed to die, and yellow-tagged clients have major injuries. Clients belonging to these three categories usually do not make up the greatest number in most large-scale multicasualty situations.

Which disaster triage tag would the nurse find on victims of a mass causality event with minor injuries who arrived to a hospital in a private vehicle? o Red o Black o Green o Yellow

o Green · The green-tagged victims have minor injuries, can move themselves to the hospital from a mass causality scene in a private vehicle, and are also called "walking-wounded" victims. Red-tagged victims can't ambulate themselves because they are severely injured. The black-tagged victims are dead or expected to die and require ambulances to transfer them. The yellow-tagged victims can have large wounds that require assistance to ambulate.

In a mass casualty situation, which is the facility-level organizational model for disaster management used by the hospital or long-term care facility? o Emergency operations center (EOC) o Hospital Incident Command System (HICS) o National Incident Management System (NIMS) o Federal Emergency Management Agency (FEMA)

o Hospital Incident Command System (HICS) · The facility-level organizational model for disaster management is the HICS. It attempts to standardize disaster operations by formally structuring roles under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources. The EOC, NIMS, and FEMA are not facility-level organizational models for disaster management. The EOC is established by the HICS personnel in a designated location with accessible communication technology to manage the overall incident. The NIMS is the overall system for incident management of which the HICS is a part; it is implemented by the Department of Homeland Security and FEMA. The FEMA provides numerous online resources so that people are better prepared for disasters and are able to respond more self-sufficiently to incidents and hazard situations in their own communities.

Which would the nurse consider to be an example of a potential internal disaster? o Hospital fire o Fertilizer plant explosion o Nuclear reactor explosion o Terrorist device explosion

o Hospital fire · An internal disaster is any kind of event inside a health care facility or campus that could endanger the safety of clients or health care staff. A fire in a hospital is an example of an internal disaster that can cause harm to the clients and the staff. A fertilizer plant explosion is an external disaster. A nuclear reactor explosion may cause radiation exposure to the external environment. Terrorism with explosive devices is an external disaster.

Which personnel would the nurse state are responsible for deciding the number, acuity, and resources needed for clients during a disaster? o Triage officer o Community relations officer o Medical command physician o Hospital incident commander

o Hospital incident commander · Medical command physicians have the authority to decide the number, acuity, and resources needed for clients during a disaster. Triage officers are the primary health care providers or nurses who are responsible for evaluating the clients rapidly and determining the priority of treatment. The community relations officer serves as a liaison between the health care facility and the media. Hospital incident commanders act as leaders and are responsible for implementing the emergency plan.

During an external disaster, which member of the hospital incident command system has the authority to rapidly expand hospital capacity and ensure the availability of medical supplies to the nurse as a function of an emergency response plan? o Triage officer o Medical command physician o Hospital incident commander o Community public information officer

o Hospital incident commander · The hospital incident commander is a primary health care provider or administrator who assumes overall leadership for implementing the emergency response plan. He or she has the authority to rapidly expand hospital capacity, recruit paid or volunteer staff, and ensure the availability of medical supplies as a function of an emergency response plan during an external disaster. A triage officer is a primary health care provider or nurse who rapidly evaluates each client to determine priorities for treatment. A medical command physician is the personnel who decides the number, acuity, and resource needs of the clients. A community public information officer is a person who serves as a liaison between the health care facility and the media.

Which intervention is a part of the response phase of disaster planning? o Stabilizing the community o Limiting the impact of disaster o Implementing the disaster plan o Evaluating the events of disaster management

o Implementing the disaster plan · The response phase of disaster management deals with the implementation of the disaster plan. The recovery phase of disaster management involves stabilizing the community. Mitigation focuses on limiting the impact of a disaster. The last phase of disaster management focuses on evaluation of the plan.

Which scenario is an internal disaster that might delay a specialist from providing on-time treatment to a client? o A tornado near the hospital o An earthquake near the hospital premises o Severe flooding o Lack of communication because of a damaged telephone system in the hospital

o Lack of communication because of a damaged telephone system in the hospital · An event inside the health care facility that could endanger the safety of clients or staff indicates internal disaster. Other examples of internal disasters include fire, explosion, and loss of critical utilities such as electricity, water, and communications capabilities. The delay in treating the client in the emergency department due to a damaged telephone system indicates internal disaster. Tornados, severe storms, and earthquakes are external disasters that are responsible for delayed treatment.

Which type of trauma center would the nurse consider to be most appropriate for a client who survived an accidental fire and has multiple injuries? o Level I o Level II o Level III o Level IV

o Level II · Level II trauma centers provide care to the most injured clients. Level III trauma centers stabilize clients with multiple injuries. Level I trauma centers provide a full continuum of trauma services for all clients. Level IV provides advanced life support and basic trauma client stabilization.

Which responsibility would the nurse manager assume when designated as a unit chief during the formulation of a Hospital Incident Command System (HICS) for disaster preparedness? o Public information o Medical command o Safety and security o Logistics and operation

o Logistics and operation · The facility-level organizational model for disaster management is HICS, which is a part of the National Incident Management System (NIMS) implemented by the Department of Homeland Security and the Federal Emergency Management Agency (FEMA) to standardize disaster operations. In this system, roles are formally structured under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources. Chiefs are appointed to manage logistics, planning, finance, and operations as appropriate to the type and scale of the event. Officers, not chiefs, are named to oversee essential emergency preparedness functions such as public information, safety and security, and medical command.

Which medical relief team would the nurse expect to help health care facilities that face personnel shortages during a mass casualty event? o Medical Reserve Corps (MRC) o Disaster Medical Assistance Team (DMAT) o Hospital Incident Command System (HICS) o International Medical-Surgical Response Teams (IMSRTs)

o Medical Reserve Corps (MRC) · MRC is a group of volunteer medical and public health care professionals. MRC helps health care settings that face personnel shortages in a mass casualty event. DMAT is a team of civilian medical, paraprofessional, and support personnel that supplies medical equipment to sustain operations for 72 hours. HICS is a facility-level organizational model to standardize disaster operations. IMSRTs provide fully functional field surgical facilities in a mass casualty event whenever needed.

Which disaster management team provides voluntary medical service to people? o Medical Reserve Corps (MRC) o Disaster Medical Assistance Team (DMAT) o National Veterinary Response Teams (NVRT) o Disaster Mortuary Operational Response Teams (DMORT)

o Medical Reserve Corps (MRC) · MRCs are groups of volunteers, consisting of medical and public health professionals, who offer voluntary support and aid during disaster management. DMAT, NVRT and DMORT are part of the National Disaster Medical System (NDMS), which deploys personnel from various other regions.

Which health care personnel working at an emergency operation center (EOC) is responsible for calling the infectious disease health care provider during a mass casualty swine flu outbreak if the need is identified? o Triage officer o Public information officer o Medical command physician o Hospital incident commander

o Medical command physician · Medical command physician in the EOC is responsible for identifying the need for and calling in specialty providers such as an infectious disease health care provider. The public information officer serves as a liaison between the health care facility and the media. The triage officer evaluates each client to determine priorities for treatment. The hospital incident commander assumes leadership for implementing the institutional plan.

Which personnel are responsible for identifying the need for and calling in specialty trained providers in emergencies? o Triage officer o Public information officer o Medical command physician o Hospital incident commander

o Medical command physician · The medical command physician is responsible for identifying the resource needs of the clients. The medical command physician identifies the need for and calls in the specialty trained providers in emergencies. Triage officers are responsible for rapidly evaluating each client to determine priorities for treatment. The public information officer serves as a liaison between the health care facility and the media. The hospital incident commander is the one who assumes overall leadership for implementing the emergency plan.

Which phase of disaster management involves attempts to limit the disaster's impact on the population? o Recovery o Response o Mitigation o Preparedness

o Mitigation · Mitigation is the phase of disaster management where attempts are made to limit the impact of a disaster on human and community welfare. The recovery phase is associated with stabilizing the community after a disaster. The implementation phase of a disaster plan is the response phase. Preparedness is the protective plan, which assesses the risk and evaluates the damage.

Which phase in the disaster management continuum would the nurse understand as including the attempt to limit a disaster's impact on human health and community function? o Recovery o Response o Mitigation o Preparedness

o Mitigation · There are five phases in the disaster management continuum, which include preparedness, mitigation, response, recovery, and evaluation. In mitigation, there will be plans for attempting to limit a disaster's impact on human health and community function. Recovery includes focusing on stabilizing the community and returning it to the previous status. Response includes implementation of the disaster plan. Preparedness is the preparation of a protective plan that is designed before the event has occurred.

Which findings in factory workers who survived a thermal blast would the nurse consider as confirmation of second-degree burns? o Dry eschar and skin appears waxy white o Leathery bleb and skin appears dark brown o Moist blebs and skin appears mottled white or pink o Pain and redness with moderate to severe tenderness

o Moist blebs and skin appears mottled white or pink · The presence of moist blebs and mottled white or pink appearance of the skin indicates second-degree burns. Presence of dry eschar, leathery bleb, and waxy white or dark brown skin indicates third-degree burns. The presence of pain and redness of the skin indicates superficial burns that are first-degree burns.

Which statement describes the purpose of a community emergency response team (CERT)? o Organizes untrained volunteers to help victims after a disaster o Assists with staffing hospitals when victims arrive after a disaster o Trains health care professionals in lifesaving skills to help victims of a disaster o Reduces the need for professional services after a mass casualty incident

o Organizes untrained volunteers to help victims after a disaster · CERTs organize untrained volunteers to assist with victims after a disaster. CERTs are an extension of the first responder services and do not staff hospitals. CERTs are composed of community members, not health care individuals. Community members, not health care professionals, are trained in lifesaving skills. CERTs offer immediate help to victims until professional services arrive. They do not take the place of professional services after a mass casualty incident.

Which team is responsible for providing prehospital care such as continuous cardiac monitoring, advanced airway management, and intubation in a group of clients who are severely injured from a fire? o Paramedics o Ancillary nursing staff o Psychiatric crisis nurse team o Emergency medical technicians (EMTs)

o Paramedics · Paramedics are advanced life support (ALS) providers who can perform advanced techniques during prehospital care disaster management. This includes cardiac monitoring, advanced airway management, intubation, establishing intravenous access, and administering medications to clients. Ancillary nursing staff assists wherever needed and as qualified at the primary care facility. The psychiatric crisis nurse team is one of the specialized teams in the emergency department. Many clients with acute health conditions may also have chronic mental disorders, and this team will improve the quality of care to the clients with specialized interventions. EMTs offer basic life support (BLS) interventions such as oxygen, basic wound care, splinting, and spinal immobilization.

Which is the purpose of critical incident stress debriefing (CISD) after a disaster? o Evaluate the outcomes of the care provided. o Prevent post-traumatic stress disorder (PTSD). o Ensure all documentation has been completed. o Determine if role assignments need to be adjusted.

o Prevent post-traumatic stress disorder (PTSD). · The CISD addresses precrisis through postcrisis interventions. After working through the turmoil and the emotional impact of the incident as well as the aftermath, the staff may find it difficult to "get back to normal." Without intervention during and after the emergency, they may develop PTSD. The CISD is not conducted to evaluate outcomes of care, ensure documentation is completed, or analyze role performance during the disaster.

Which features would the emergency department (ED) nurse use from an automated tracking system for triage during mass casualty incidents (MCIs)? Select all that apply. o Priority upon arrival o Clinical manifestations o Interaction with caregivers o Priority per process of care o Priority according to location

o Priority upon arrival o Interaction with caregivers o Priority per process of care o Priority according to location · Automated tracking systems using infrared and radiofrequency technology (RFT) are available in some EDs to track a client's triage priority upon arrival, location, and process of care. The interactions the client has with caregivers can also be tracked; this is an important safety strategy if the client is later found to have contaminants or a disease that could pose a risk to staff members who had close contact and require decontamination or prophylaxis. Clinical manifestations cannot be tracked using this system.

Which activity would the nurse manager complete during an emergency event when acting as the triage officer according to the Hospital Incident Command System (HICS)? Select all that apply. o Facilitating client movement through the system o Bringing in personnel and supply resources to meet needs o Rapidly evaluating each person who comes to the hospital o Identifying the need for and call in specialty providers o Determining numbers, acuity, and medical resource needs of clients arriving at the hospital

o Rapidly evaluating each person who comes to the hospital · In the role of triage officer, the nurse would rapidly evaluate each person who comes to the hospital, including those triaged in the field. The hospital incident commander facilitates client movement through the system and brings in personnel and resources to meet needs. The medical command physician identifies the need for and calls in needed specialty providers and determines the number, acuity, and medical resource needs of clients arriving at the hospital.

Which phase of critical incident stress debriefing (CISD) is indicated during a CISD session when a client who survived a natural disaster says, "The worst thing that happened on that day was that my child was severely injured and I was not in a position to help. I would like to forget that day as soon as possible. It was the most painful experience of my life"? o Reentry phase o Thought phase o Reaction phase o Symptom phase

o Reaction phase · In the reaction phase, CISD participants talk about the worst thing of the incident - what they would like to forget and what was most painful. In the reentry phase, participants review materials discussed, ask questions, and discuss how they would like to bring closure to the debriefing. In the thought phase, participants discuss their first thoughts of the incident. In the symptom phase, participants describe their physical, cognitive, emotional, or behavioral experiences that happened at the incidence scene.

Which statement would the nurse know to be true regarding the characteristics of sarin? o Sarin causes skin burns and blisters. o Sarin can cause death within minutes of exposure. o A garlic-like odor and brown color are characteristics of sarin. o A single dose of pralidoxime chloride (2-PAM chloride) reverses the effects of long-term sarin exposure.

o Sarin can cause death within minutes of exposure. · Sarin is a highly toxic nerve gas that can cause death within minutes of exposure. Mustard gas causes skin burns and blisters. A garlic-like odor and brown color are characteristics of mustard gas. Although pralidoxime chloride (2-PAM chloride) is used as an antidote for nerve agent poisoning, multiple doses may be needed to reverse the effects of nerve agents; also, sarin acts by paralyzing the respiratory muscles.

Which individual would be an appropriate member of a critical incident stress debriefing (CISD) team for a group of staff nurses? Select all that apply. o Staff nurse o Organization chaplain o Organization media representative o Primary health care provider trained in critical debriefing o Advanced practice mental health nurse

o Staff nurse o Primary health care provider trained in critical debriefing o Advanced practice mental health nurse · The CISD team includes a peer member of the group being debriefed. For this group, the CISD team would include a staff nurse. The team may include a primary health care provider trained in critical debriefing. The team leader would be someone with a background in mental or behavioral health. This role would be appropriate for the advanced practice mental health nurse. The chaplain and the media representative are not identified as being appropriate for the CISD team.

Which conditions are given a green tag according to triage disaster tag system? Select all that apply. o Strains o Abrasions o Open fractures o Airway obstruction o High cervical spinal cord injury

o Strains o Abrasions · A green tag is issued for clients who are nonurgent or classified under class III. Strains and abrasions are considered minor injuries and nonurgent. Walking wounded clients with minor injuries are triaged under this category. Clients with open fractures and who can wait some time for care are issued yellow tags and triaged under class II. Clients with airway obstruction are issued red tags and triaged under class I. Clients with high cervical spinal cord injury are issued black tags because they are expected to die and are categorized under class IV.

Which role does the "doorkeeper" enact in a critical incident stress debriefing (CISD) team? o Helping dispel any feelings of blame or guilt in the participants o Encouraging group discussion through asking a series of questions o Educating participants about self-care concepts and coping strategies to use immediately o Talking with anyone who leaves the session early in an effort to have him or her return or accept follow-up

o Talking with anyone who leaves the session early in an effort to have him or her return or accept follow-up · The role of the "doorkeeper" is to keep inappropriate people like the media and spectators out and to talk with anyone who leaves the session early in an effort to have him or her return or accept follow-up. The CISD group leader helps dispel any feelings of blame or guilt in the participants, encourages group discussion through asking a series of questions, and educates participants about self-care concepts and coping strategies to use immediately.

When the triage nurse assigns a green tag to a client during triage after a mass casualty event, which statement is true about the client's injuries? o The client is expected and allowed to die. o The client has an immediate threat to life. o The client has major injuries that require treatment. o The client has minor injuries that do not require immediate treatment.

o The client has minor injuries that do not require immediate treatment. · The green tag is assigned to the client who has minor injuries that do not require immediate treatment. The client who is expected and allowed to die will be given a black tag. The client who has an immediate threat to life will be given a red tag. The client who has major injuries that require treatment is given a yellow tag.

Which assignments are appropriate when the head nurse of the emergency department (ED) is assigning duties to volunteer nurses to care for a group of clients injured in a mass casualty situation? Select all that apply. o The general staff nurse would organize nursing services. o The trauma nurse manager would organize ancillary services. o The medical-surgical nurse would recommend clients for discharge. o The ED nurse leader would direct the ancillary departments to deliver supplies. o The hospital nurse leader would identify clients who can be transferred out of the unit.

o The trauma nurse manager would organize ancillary services. o The medical-surgical nurse would recommend clients for discharge. o The ED nurse leader would direct the ancillary departments to deliver supplies. · While caring for clients after a disaster, the trauma nurse manager would help in organizing ancillary services to meet client needs. The medical-surgical nurse would collaborate with the primary health care provider in recommending clients for discharge to free inpatient beds. The ED nurse leader would direct the ancillary departments to deliver supplies to meet service needs. The general staff nurse would organize nursing services to provide care for stable emergency department clients. The hospital nurse leader would direct the ancillary departments to deliver supplies, medications, food, instrument trays, and personnel to meet service needs.

After a bomb blast in a city, why would the federal government send the Medical Reserve Corps (MRC) to the site? o To provide advanced Disaster Life Support training o To establish first aid stations or special-needs shelters o To establish fully functional field surgical facilities to victims o To provide medical equipment sufficient for 72 hours to victims

o To establish first aid stations or special-needs shelters · The MRC helps establish first aid stations or special-needs shelters to victims of a disaster. The National Disaster Life Support Foundation renders core, basic, and advanced disaster life support training courses. International Medical-Surgical Response Teams (IMSRTs) establish fully functional field surgical facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.

Which is essential for ensuring disaster readiness in a community? o Trauma system o State government o Federal government o Emergency response system

o Trauma system · A well-functioning trauma system is essential to general public health and safety. It provides the structure necessary for disaster readiness and community emergency preparedness. Although most states now have at least some basic elements of a trauma system in place, significant gaps still exist in many regions. The federal government may provide oversight for disaster readiness; however, it does provide the fundamental structure. The emergency response system is one aspect of disaster readiness; however, it does not provide the structure.

Which role is the nurse likely performing while assessing then assigning a yellow tag to a survivor of a massive tsunami? o Triage officer o Public information officer o Medical command physician o Hospital incident commander

o Triage officer · A triage officer is expected to evaluate clients quickly, determine treatment needs, and tag the clients accordingly. A public information officer serves as a liaison between the health care facility and the media. The medical command physician assesses the probable in-client admissions and the expected resource needs of the client. Leadership for implementing the emergency plan is assumed by the hospital incident commander.

Which factors will influence the amount of stress community members might experience after flooding and building damage caused by a category 4 hurricane? Select all that apply. o Type of disaster o Age of the community members o Financial status and employment o Previous medical and psychological histories o Preexisting mechanisms to cope with disasters

o Type of disaster o Age of the community members o Previous medical and psychological histories o Preexisting mechanisms to cope with disasters · All disasters result in psychological stress, which is influenced by the type of disaster, the age of the individuals who are affected by the disaster, the medical and psychological histories of the people affected by the disaster, and preexisting coping mechanisms of the people affected by the disaster. Financial status and employment are not identified as influencing factors of psychological response after a disaster.

Which action by nursing staff during a facility fire drill requires correction? Select all that apply. o Directing ambulatory clients to walk to a safe area o Discontinuing oxygen for all clients able to breathe without it o Closing all doors and windows after clients are safely removed o Use of an ABC extinguisher to put out a small trash can fire before evacuation o Asking the ambulatory clients to help evacuate several wheelchair-bound clients

o Use of an ABC extinguisher to put out a small trash can fire before evacuation · All clients should be safely removed before attempting to extinguish a fire. Directing ambulatory clients to walk to a safe area, discontinuing oxygen for those who can breathe without it, closing all doors and windows after safely removing clients, and asking ambulatory clients to help evacuate wheelchair-bound clients are all appropriate staff responses during a fire drill.

Which personnel of the institutional emergency response plan serves as a liaison between hospital administration and the media during a mass casualty incident such as an earthquake or a terrorist attack? o Triage officer o Medical command physician o Hospital incident commander o Community public information officer

o Community public information officer · The community public information officer is a person who serves as a liaison between the health care facility and the media releasing only appropriate or accurate information about the incident. A triage officer is a primary health care provider or nurse who rapidly evaluates each client to determine priorities for treatment. A medical command physician is the personnel who decides the number, acuity, and resource needs of the clients. A hospital incident commander is a primary health care provider or administrator who assumes overall leadership for implementing the emergency plan.

A group of bomb blast victims needs to be transported to the hospital immediately. Which staff members of an emergency unit are most appropriate to handle this situation? o Triage officer o Medical command physician o Prehospital care providers o Emergency medicine physician

o Prehospital care providers · Prehospital care providers are the first caregivers who provide transport to the emergency department by ambulance or helicopter for clients in an emergency situation. Triage officers are responsible for evaluating each client to determine priorities for treatment. The medical command physician decides the number, acuity, and resource needs of clients. Emergency medicine health care providers have specialized education and training in emergency client management.

In which phase of the disaster management continuum would the nurse state are developing emergency response plans in case of an earthquake alert is included? o Response o Recovery o Mitigation o Preparedness

o Preparedness · The first phase of the disaster management continuum is preparedness. This is a protective plan designed before the event to structure the response, assess the risk, and evaluate the response. The response phase of the disaster continuum includes the actual implementation of the disaster plan. The recovery phase is related to actions focusing on stabilization of the community and returning it to the previous state. The mitigation phase includes attempts to limit a disaster's impact on human health and community function.

Which action of the emergency department nurse caring for a group of clients injured in a community disaster would need correction? o Triaging the victims o Supervising volunteers o Providing on-site first aid o Removing people from danger

o Removing people from danger · During a community disaster, removing people from danger is done by firefighters and other disaster trained emergency personnel. Nurses would not be involved in this process. After the removal of people from danger, the nurses triage the victims under triage categories. The nurses supervise volunteers and provide on-site first aid to victims.

Which statements made by the nurse training the emergency department caregivers about types of disasters would describe a mass casualty event? Select all that apply. o "In an aircraft explosion, nearly 112 persons died." o "There was a fire in a health care facility in Canada." o "In 2001, there was a terrorist attack on the World Trade Center." o "There was a small chemical explosion at a medical college 5 years ago." o "The employees at a nuclear plant were severely injured by a radiation leak."

o "In an aircraft explosion, nearly 112 persons died." o "In 2001, there was a terrorist attack on the World Trade Center." o "The employees at a nuclear plant were severely injured by a radiation leak." · Mass casualty events require the collaboration of multiple agencies and health care facilities to handle the crisis. An aircraft explosion, a terrorist attack, and a nuclear explosion are external disasters that will require the collaboration of multiple agencies. A fire in a health care facility and a small chemical explosion at a medical college are examples of multicasualty events that can be managed using local resources.

Which triage class client would the nurse plan to treat first according to the disaster triage tag system? o Class I o Class II o Class III o Class IV

o Class I · Class I clients are emergent clients who are marked with a red tag. These clients have an immediate threat to life and need attention first. Class II clients have major injuries and need treatment within 30 minutes to 2 hours. Class III clients have minor injuries and can be treated in a delayed manner. Class IV clients are those who are expected to die or are dead.

Which statement is true about the disaster triage tag system? o Yellow tags are given to "walking-wounded clients." o Clients who are in shock are given a black tag. o Clients with airway obstruction, who require immediate attention, are given a red tag. o Green tags are given to clients who require treatment within 30 minutes to 2 hours of admission.

o Clients with airway obstruction, who require immediate attention, are given a red tag. · Red tags are given to clients with conditions such as airway obstruction and shock, who have immediate threats to life and should be treated immediately. Shock is a condition requiring immediate care and therefore should be given a red, not black, tag. "Walking-wounded clients" are given a green tag. Clients who are not expected to live or are dead are given a black tag. Clients who sustained major injuries and need to be treated in 30 minutes to 2 hours should be given a yellow tag.

Which is the purpose of an administrative review debriefing session after a disaster? o Change responsibility roles. o Prevent the development of burnout. o Analyze the amount of resources used. o Determine what went right and what went wrong.

o Determine what went right and what went wrong. · The goal of the administrative review debriefing is to discern what went right and what went wrong during activation and implementation of the emergency preparedness plan. This debriefing is not used to change responsibility roles. Preventing the development of burnout is the goal of critical incident stress debriefing (CISD). Analyzing resource use would occur after the disaster plan is discontinued.

Which nursing behavior is essential when working with leadership personnel during the activation of the emergency preparedness plan? o Triage o Assessment o Collaboration o Resource management

o Collaboration · During an actual disaster, the nurse works in collaboration with leadership personnel to organize nursing and ancillary services to meet client needs. Although essential nursing skills, triage, assessment, and resource management are not identified as being essential when working with leadership personnel during a disaster.

Which type of fracture does the client admitted to the emergency department after a bomb blast who is given a yellow tag most likely have? o Compound fracture o Transverse fracture o Green stick fracture o Comminuted fracture

o Compound fracture · A yellow tag would be issued for class II clients who may have major injuries such as open or compound fractures. In an open or compound fracture, the bone sticks through the skin. Clients with compound fractures need urgent treatment but can wait a short time for care. Green stick fractures, transverse fractures, and comminuted fractures are closed fractures and are considered minor injuries. Clients with minor injuries are issued with green tags.

Which function is performed by the emergency department nurse leader? o Providing care for stable emergency department (ED) clients o Assisting in monitored care of the client o Transporting the clients to the critical care unit o Directing ancillary departments to deliver resources to meet service demands

o Directing ancillary departments to deliver resources to meet service demands · Directing ancillary departments to deliver resources to meet service demands is the function of the ED nurse leader. General staff nurses provide care for stable ED clients. They also supplement the ED nurses to assist in monitored care and transport to critical care units.

Which team would be mobilized to manage the deceased at the earthquake zone where many people lost their lives? o Medical Reserve Corps (MRC) o National Veterinary Response Teams (NVRTs) o International Medical-Surgical Response Teams (IMSRTs) o Disaster Mortuary Operational Response Teams (DMORTs)

o Disaster Mortuary Operational Response Teams (DMORTs) · DMORTs are a part of the DMAT. This team is specialized in managing mass fatalities during a disaster. The MRC helps staff hospitals or community health care settings that face shortages of nurses. They establish first aid stations and special-needs shelters in disasters. NVRTs provide emergency care to animals. IMSRTs provide fully functional field surgical facilities all over the world, wherever it is required.

Which action is appropriate for the nurse who is the triage officer after a high-speed commuter train derailment? o Evaluating each client to determine priorities for treatment o Being a liaison between the health care facility and the media o Deciding the number, acuity, and resource needs for client care o Assuming leadership for the implementation of the emergency plan

o Evaluating each client to determine priorities for treatment · The triage officer is a primary health care provider or nurse who rapidly evaluates each client to determine priorities for treatment. The community relations or public information officer is a liaison between the health care facility and the media. The medical command health care provider decides the number, acuity, and resource need for client care. The hospital incident commander is a primary health care provider or administrator who assumes leadership for implementation of the emergency plan.

Which are examples of internal disasters that must be accounted for when formulating a disaster response plan? Select all that apply. o Fire o Hurricane o Earthquake o Power outage o Act of terrorism

o Fire o Power outage · Examples of internal disasters that must be accounted for when formulating a disaster plan include fire and power outage. A hurricane and earthquake, both natural disasters, are classified as external disasters. An act of terrorism is also considered an external disaster.

Which functional level of trauma center is involved in providing a full continuum of trauma services? o Level I o Level II o Level III o Level IV

o Level I · Level I trauma centers provide a full continuum of trauma services for all clients. Level II trauma centers provide care for most injured clients. Level III centers are able to stabilize clients with major injuries, but must transport clients if needs exceed resource capabilities. Level IV trauma centers are usually involved in providing basic trauma client stabilization and advanced life support within the resource capabilities. They are also responsible for the transfer of clients if need exceeds the resource competencies.

Which threats included in the term "NBC" lead to the implementation of improved emergency medical services (EMS) and hospital safety programs? Select all that apply. o Nuclear o Biological o Botulism o Chemical o Nipah virus

o Nuclear o Biological o Chemical · The term "NBC" was coined to describe nuclear, biological, and chemical threats. In response, EMS agencies and hospitals improved safety by upgrading their decontamination facilities, equipment, and all levels of personal protective equipment to better protect staff. Botulism and Nipah virus are two specific examples of biological threats.

Which team would the nurse consider to be responsible for the treatment of the client rescued from a fire who was found unconscious and having difficulty breathing? o Paramedics o Prehospital care providers o Emergency medicine physicians o Emergency medical technicians (EMTs)

o Paramedics · An unconscious client who is unable to breathe may require intubation. Paramedics are the advanced life support (ALS) providers who can perform advanced techniques that include cardiac monitoring, advanced airway management, and intubation. Prehospital care providers are the first caregivers who provide preliminary care in an ambulance or a helicopter before the client is admitted to the emergency department. Emergency medicine physicians have special education and training in emergency client management. EMTs are responsible for providing the basic life support interventions such as oxygen, basic wound care, monitoring of vital signs, etc.

Which emergency medical service (EMS) health care professional provides advanced life support to the clients who survived a large-scale disaster? o Paramedics o Triage officer o Prehospital care providers o Emergency medical technicians

o Paramedics · Paramedics provide advanced life support such as cardiac monitoring and establishing intravenous access to the clients who survived a large-scale disaster. A triage officer rapidly evaluates each client to determine priorities for treatment. Prehospital care providers are the first caregivers that clients see before transport to the emergency department (ED) by an ambulance or helicopter. Emergency medical technicians provide basic life support interventions such as oxygen and basic wound care to the clients who survived large-scale disaster.

Which nursing behavior helps establish rapport with survivors of a disaster? o Evaluating o Assessing o Collaborating o Active listening

o Active listening · Rapport can be established through active listening. Evaluating and assessment are steps in the nursing process and are not helpful to establish rapport. Collaboration is a behavior best used when working with others during the active stages of a disaster.

To which disaster triage class would the nurse infer a client with a green triage tag belongs? o Class I o Class II o Class III o Class IV

o Class III · The green disaster triage tag is issued to nonurgent or "walking-wounded" clients who belong to class III. A red disaster triage tag is issued to clients who require immediate treatment and belong to class I. Clients with yellow and black tags belong to class II and IV respectively.

Which health care team member is a first responder when an emergency or mass casualty incident (MCI) occurs? o Medical unit nurse o Police officer o Critical care nurse o Unlicensed assistive personnel

o Critical care nurse · Critical care nurses are often considered emergency medical personnel that respond to emergency or MCIs. Firemen and police officers are first responders but are not members of the health care team. Unlicensed assistive personnel are not first responders.

Clients with which tag are referred to as "walking wounded" clients while managing a disaster? o Red o Black o Green o Yellow

o Green · Clients who sustained minor injuries during a disaster and can evacuate themselves are referred to as "walking wounded" clients and are green-tagged. Red tags are given to clients who have immediate threats to their life and should be treated immediately. Black tags are given to clients who are not expected to live or are dead. Yellow tags are given to clients who sustained major injuries and need treatment within 30 minutes to 2 hours.

Which amount of time is appropriate for the nurse to spend triaging each client during a mass casualty incident (MCI)? o Less than 10 seconds o Less than 15 seconds o Less than 30 seconds o Less than 60 seconds

o Less than 15 seconds · Triage of victims of an emergency or an MCI must be conducted in less than 15 seconds. The other time frames, 10 seconds, 30 seconds, and 60 seconds, are not accurate.

After a mass casualty incident related to an accidental fire in a residential area, which condition are the clients experiencing when they present with incoherence, panic attacks, and exaggerated startle responses? o Ineffective coping o Post-trauma syndrome o Compromised resilience o Disturbed personal identity

o Post-trauma syndrome · Incoherence, panic attacks, and exaggerated startle responses are symptoms of post-trauma syndrome. Ineffective coping and compromised resilience is characterized by an inability to meet basic needs, inadequate problem-solving, inability to attend to information, and isolation. Disturbed personal identity is manifested as self-hatred, feelings of being ineffectual, and perceived lack of control.

Which nursing resource must be available to effectively meet potential needs during a disaster? Select all that apply. o Staff o Medication o Hospital beds o Mechanical ventilators o Personal protective equipment

o Staff o Medication o Hospital beds o Mechanical ventilators o Personal protective equipment · Preparation for disasters includes ensuring resources are available to meet potential needs. The nurse leader must ensure there is adequate staff, medication, hospital beds, medical devices such as mechanical ventilators, and personal protective equipment available to address potential needs during a disaster.

Which color tag will be given by the triage nurse to a client assigned to class IV during a mass casualty situation? o Red o Black o Green o Yellow

o Black · A client considered class IV during triage in a mass casualty situation will be given a black tag. The red tag is associated with class I, green tag with class III, and yellow tag with class II.

Which role does the federal government play in emergency preparedness? o Trains staff o Stockpiles critical equipment o Checks for completion of disaster drills o Ensures all organizations have fire drills

o Stockpiles critical equipment · The U.S. government stockpiles critical equipment and supplies in the event of an emergency. The federal government does not train staff, check for completion of disaster drills, or ensure all organizations have fire drills.

Which statement about the psychosocial response of clients when assessing survivors of a mass casualty event made by the nurse executive indicates the need for further explanation? o "I should establish a rapport through honest communication." o "I should use the Impact of Event Scale-Revised in clients with short-term memory loss." o "I should determine the client's reading level before giving the Impact of Event Scale-Revised tool." o "I should refer the clients with a high score on the Impact on the Event Scale-Revised to a psychiatrist."

o "I should use the Impact of Event Scale-Revised in clients with short-term memory loss." · The use of the Impact of Event Scale-Revised (IES-R) scale should be avoided in clients with short-term memory loss. The nurse should establish a rapport through honest communication to help the survivors of a mass casualty event. Determining the client's reading level is important before giving IES-R tool because it is written at the tenth-grade reading level. The clients with high score on the IES-R are to be referred to a psychiatrist.

Which is the minimum length of time victims of a large scale near-drowning incident brought to the emergency department would be kept under observation in the hospital? o 12 hours o 18 hours o 23 hours o 48 hours

o 23 hours · Complications can develop in victims who are essentially free of symptoms immediately after a near-drowning episode. This secondary drowning refers to delayed death from drowning due to pulmonary complications. Consequently, all victims of near-drowning should be observed in a hospital for a minimum of 23 hours, and longer if they have comorbidities. Twelve hours and 18 hours are too soon to rule out secondary drowning. The clients need not be kept under observation for 48 hours if they do not have comorbidities.

Which internal disaster would the nurse explain requires a need for evacuation or relocation? o Tornado o Hurricane o Facility gas explosion o Terrorism with explosive devices

o Facility gas explosion · A facility gas explosion is an internal disaster, which requires a need for evacuation or relocation. Tornados and hurricanes are natural, external disasters. Terrorism with the use of explosive devices is also an external disaster.